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Savvas Andronikou

Publications and source records attributed to Savvas Andronikou.

At least 19 recordsLinked to original sources
PubMed2007

Systemic juvenile xanthogranulomatosis imitating a malignant abdominal wall tumor with lung metastases.

Juvenile xanthogranulomatosis (JXG) is a rare benign condition, which usually presents with characteristic skin lesions and can be diagnosed clinically. However, systemic JXG may involve a wide range of extracutaneous sites and may pose a diagnostic dilemma for the clinician, radiologist, and pathologist. In particular it may simulate malignancy. Here, we report a case of systemic JXG within the abdominal wall musculature and lungs, which imitated a sarcoma with pulmonary metastases on computerized tomography. To the best of our knowledge, this is the first such reported case. In particular, systemic disease presenting without skin lesions is unusual.

Abdominal Neoplasms↗
PubMed2006

CT features of tuberculous intracranial abscesses in children.

BACKGROUND: Intracranial tuberculous (TB) abscesses still cause a diagnostic dilemma on both CT and MRI as they may mimic neoplasms. Recognition of TB abscesses may prompt further imaging and appropriate trial of therapy, and may reduce the need for biopsy. OBJECTIVE: To report the CT features of eight intracranial TB lesions in children initially diagnosed as neoplasms and eventually treated as TB abscesses. MATERIALS AND METHODS: We undertook a 3-year retrospective review of children with an initial CT diagnosis of intracranial neoplasm who were subsequently diagnosed as having TB abscesses. RESULTS: Eight patients out of 60 with an initial diagnosis of a neoplasm on CT were misdiagnosed and were ultimately determined to have TB abscesses after biopsy or a trial of anti-TB therapy. The most consistent constellation of findings for the lesions were low density (n = 5), ring enhancement (n = 8), cerebral hemisphere location (n = 7), mass effect (n = 6), surrounding oedema (n = 5) and absence of a soft-tissue-density mass (n = 8). CONCLUSION: In endemic regions, intracranial lesions with these appearances on CT should undergo further imaging and possibly a trial of anti-TB therapy before considering biopsy.

Brain Abscess↗
PubMed2006

Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months.

BACKGROUND: Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. OBJECTIVE: To correlate the distribution of infarction in children with TBM on CT with an outcome score (OS). MATERIALS AND METHODS: CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. RESULTS: There was a statistically significant association between all sites of infarction (P = 0.0001-0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001-0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with 'any infarction' was 4.91 (CI 2.24-10.74), with 'bilateral infarctions' 8.50 (CI 2.49-28.59), with basal ganglia infarction 5.73 (CI 2.60-12.64), and for hemispheric infarction 2.30 (CI 1.00-5.28). CONCLUSION: Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT.

Adolescent↗
PubMed2006

Localized basal meningeal enhancement in tuberculous meningitis.

BACKGROUND: Focal basal meningeal enhancement may produce a confusing CT picture in children with suspected tuberculous meningitis (TBM). OBJECTIVE: To demonstrate the incidence, distribution and appearance of localized basal meningeal enhancement in children with TBM. MATERIALS AND METHODS: CT scans of patients with definite (culture proven) and probable (CSF suggestive) TBM were retrospectively evaluated by two observers. Localized basal enhancement was documented as involving: unilateral cistern of the lateral fossa (CLF), unilateral sylvian fissure, unilateral CLF and sylvian fissure in combination, unilateral CLF and sylvian fissure with ipsi- or contralateral ambient cistern and isolated quadrigeminal plate cistern. RESULTS: The study included 130 patients with TBM (aged 2 months to 13 years 9 months). Focal basal enhancement was seen in 11 patients (8.5%). The sylvian fissure was involved most commonly, followed by the lateral fossa cistern. The ambient cistern was involved in three patients and the quadrigeminal plate cistern in one. Focal areas of enhancement corresponded to the areas of infarction in every patient. CONCLUSION: Focal basal meningeal enhancement is common (8.5%) in paediatric TBM. This must be kept in mind when evaluating CT scans in children presenting with focal neurological findings, seizures or meningism in communities where TBM is endemic.

Adolescent↗
PubMed2006

Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis.

BACKGROUND: There are no widely accepted objective criteria to determine the presence of basal enhancement on CT in children with suspected tuberculous meningitis (TBM). OBJECTIVE: To test nine recently described objective CT criteria for the presence of abnormal basal enhancement in children with suspected TBM against the definite diagnosis as determined by cerebrospinal fluid (CSF) culture. MATERIALS AND METHODS: CT scans of patients with a clinical suspicion of TBM who had undergone lumbar puncture for CSF culture spanning a period of 4 years were reviewed for the presence of nine recently described criteria for the presence of abnormal basal enhancement. The radiologists were blinded to the final diagnosis based on CSF culture against which the criteria were tested. The criteria have been named: the 'Y-sign', 'linear enhancement', 'double lines', 'infundibular recess of the third', 'ill-defined edge', 'nodular enhancement', 'join the dots', 'contrast filling the cisterns', and 'asymmetry'. RESULTS: A total of 65 patients were included in the study, 34 with culture-proven TBM and 31 with other diagnoses. Four individual criteria had a specificity of 100%, but the sensitivities of these criteria ranged from 15% to 53% only. Three other criteria had specificities of 97% and sensitivities ranging from 62% to 82%. The presence of more than one criterion in the same patient showed a specificity of 97% and sensitivity of 91%. CONCLUSIONS: Very high specificity was demonstrated for all nine criteria, including 100% specificity for four individual criteria. Sensitivity was at best 82%, but improved to 91% when more than one criterion was present. These criteria need to be tested for inter- and intraobserver variability to prove their clinical usefulness.

Child↗
PubMed2006

Hepatic mesenchymal hamartoma mimicking hemangioma on multiple-phase gadolinium-enhanced MRI.

Mesenchymal Hamartoma [MH] is a cystic benign liver mass occurring in children. Diagnostic confusion with hepatoblastoma may arise when alpha-feto-protein is elevated, and with hemangioendothelioma when imaging shows centripetal filling. We demonstrate one such case with progressive centripetal enhancement of a liver mass with Gadolinium enhanced multiple phase gradient-echo MRI, in a child with raised alpha-feto protein.

Diagnosis, Differential↗
PubMed2005

Value of early follow-up CT in paediatric tuberculous meningitis.

BACKGROUND: The value of CT in the diagnosis of tuberculous meningitis (TBM) in children is well reported. Follow-up CT scanning for these patients is, however, not well described and, in particular, the value of early follow-up CT has not been addressed for children with TBM. OBJECTIVE: To assess the value of early follow-up CT in children with TBM in identifying diagnostic, prognostic and therapeutically relevant features of TBM. MATERIALS AND METHODS: A retrospective 4-year review of CT scans performed within 1 week and 1 month of initial CT in children with proven (CSF culture-positive) and probable TBM (CSF profile-positive but culture-negative) and comparison with initial CT for the diagnostic, prognostic and therapeutic CT features of TBM. RESULTS: The CT scans of 50 children were included (19 "definite" TBM; 31 "probable" TBM). Of these, 30 had CT scans performed within 1 week of the initial CT. On initial CT, 44 patients had basal enhancement. Only 24 patients had contrast medium-enhanced follow-up scans. Important findings include: 8 of 29 patients (who were not shunted) developed new hydrocephalus. New infarcts developed in 24 patients; 45% of those who did not have infarction initially developed new infarcts. Three of the six patients who did not show basal enhancement on initial scans developed this on the follow-up scans, while in seven patients with pre-existing basal enhancement this became more pronounced. Two patients developed hyperdensity in the cisterns on non-contrast medium scans. Eight patients developed a diagnostic triad of features. Three patients developed CT features of TBM where there was none on the initial scans. CONCLUSIONS: Early follow-up CT is useful in making a diagnosis of TBM by demonstrating features that were not present initially and by demonstrating more sensitive, obvious or additional features of TBM. In addition, follow-up CT is valuable as a prognostic indicator as it demonstrates additional infarcts which may have developed or become more visible since the initial study. Lastly, follow-up CT has therapeutic value in demonstrating hydrocephalus, which may develop over time and may require drainage. We advise routine follow-up CT in patients with suspected TBM within the first week of initial CT and optionally at 1 month.

Adolescent↗
PubMed2005

Cervical spina bifida cystica: MRI differentiation of the subtypes in children.

BACKGROUND: Cervical spinal dysraphism is a rare condition with only 37 cases reported in the literature, of which only seven patients had undergone preoperative magnetic resonance imaging (MRI). OBJECTIVE: By using illustrative cases, we demonstrate the value of MRI in distinguishing the two different subtypes of cervical spinal dysraphism, namely, myelocystocele and meningocele. METHOD: Retrospective review of the MRI scans of six patients with cervical (one high thoracic) posterior cystic swellings, which were diagnosed as cervical dysraphism, was done. RESULTS: Three patients were diagnosed with myelocystocele and three patients with meningocele. A comparison of MRI features between the two entities, as well as the associated anomalies, is discussed. CONCLUSION: MRI is the imaging modality of choice for suspected cervical dysraphism, prior to surgery. It helps distinguish the subtypes, as well as identify the associated anomalies.

Adolescent↗
PubMed2005

Comparing axillary and mediastinal lymphadenopathy on CT in children with suspected pulmonary tuberculosis.

BACKGROUND: Radiographic demonstration of mediastinal lymphadenopathy is important for the diagnosis of pulmonary tuberculosis (PTB). Plain radiographs are unreliable for this and CT, which is relatively more expensive and carries a high radiation burden, remains the gold standard. No studies correlating the presence of axillary with mediastinal lymphadenopathy have been reported. Such a correlation would allow for clinical or ultrasound diagnosis of PTB via the axilla. OBJECTIVE: To correlate the presence of axillary lymphadenopathy with mediastinal lymphadenopathy in children with suspected PTB. MATERIALS AND METHODS: CT scans were performed and reviewed in 100 children (prospectively recruited) with suspected PTB. The axilla and mediastinum were reviewed separately by covering the non-relevant sections on the CT scans prior to reading. Only nodes greater than 1 cm were regarded as pathological. RESULTS: Mediastinal lymphadenopathy was present in 46% of children; 70% had lymphadenopathy in either axilla. Bilateral axillary lymphadenopathy was identified in 47%. Axillary lymphadenopathy showed a sensitivity of 74% and a specificity of 33% for the presence of mediastinal adenopathy. Bilateral axillary adenopathy had a sensitivity of 50% and a specificity of 56%. CONCLUSIONS: Axillary lymphadenopathy has a moderate sensitivity and low specificity for the presence of mediastinal and hilar lymphadenopathy in children with suspected PTB. Further research should be aimed at correlating ultrasound-detected axillary lymphadenopathy with FNA results in children.

Axilla↗
PubMed2005

Interobserver variability in the detection of mediastinal and hilar lymph nodes on CT in children with suspected pulmonary tuberculosis.

BACKGROUND: The presence of mediastinal or hilar adenopathy is critical for the diagnosis of pulmonary TB. Interobserver variability in the detection of lymphadenopathy on CT in children affects the usefulness of CT as a gold standard. OBJECTIVE: To determine the interobserver variability for the detection of hilar and mediastinal adenopathy on CT in children. MATERIALS AND METHODS: One hundred children with clinically suspected pulmonary TB were prospectively recruited for CT scanning of the chest. Four observers reviewed the scans independently for the presence of lymphadenopathy at predetermined sites. Overall Kappa statistic was determined for each recognised site of mediastinal and hilar lymphadenopathy. RESULTS: Kappa statistics showed that observers only agreed moderately in their detection of lymphadenopathy. The site of best agreement was the right hilum, followed by the subcarinal, right paratracheal and precarinal locations. Observers differed most at the anterior mediastinum and left hilum. The best Kappa statistic was for the overall presence of lymphadenopathy taking all sites into account. CONCLUSIONS: Imaging techniques that are considered the gold standard for particular diseases must be validated pathologically, and if this is not possible, interobserver variability should be evaluated. CT is considered the gold standard for detecting lymphadenopathy, but we have shown only moderate agreement between readers. Readers had difficulty in distinguishing lymphadenopathy from normal thymus and were unable to distinguish normal from pathological nodes without a predetermined size threshold for abnormality. The right hilum and the sites around the carina are the most reliable for the reported presence of lymphadenopathy.

Child↗
PubMed2004

Definitive neuroradiological diagnostic features of tuberculous meningitis in children.

BACKGROUND: Although CT scanning is used widely for making the diagnosis and detecting the complications of tuberculous meningitis (TBM) in children, the radiological features are considered non-specific. CT is particularly suggestive of the diagnosis when there is a combination of basal enhancement, hydrocephalus and infarction, and even then the diagnosis may be in doubt. In this paper we introduce a new CT feature for making the diagnosis of TBM, namely, hyperdensity in the basal cisterns on non-contrast scans, and we assess which of the recognized CT features is most sensitive and specific. OBJECTIVE: To determine the sensitivity and specificity of the presence of high-density exudates in the basal cisterns (on non-contrast CT) and basal enhancement (on contrast-enhanced CT) for the diagnosis of TBM in children, and to correlate these with the complications of infarction and hydrocephalus. MATERIALS AND METHODS: Retrospective review of CT scans with readers blinded to the diagnosis, which was based on a definitive culture of cerebrospinal fluid (CSF) for TBM or other bacteria. Computer-aided conversion of hard-copy film density to Hounsfield units was employed as well as a density threshold technique for determining abnormally high densities. RESULTS: The most specific feature for TBM is hyperdensity in the basal cisterns prior to IV contrast medium administration (100%). The most sensitive feature of TBM is basal enhancement (89%). A combination of features (hydrocephalus, infarction and basal enhancement) is as specific as pre-contrast hyperdensity, but has a lower sensitivity (41%). There were statistically significant differences in the presence of hydrocephalus (p=0.0016), infarcts (P=0.0014), basal enhancement (P<0.0001) and pre-contrast density (P<0.0001) between the negative and positive TBM patient groups. The presence of granulomas was not statistically significant between the two groups (P=0.44). CONCLUSIONS: The presence of high density within the basal cisterns on non-contrast CT scans is a very specific sign for TBM in children. This will enhance diagnostic confidence, allow early institution of therapy and could reduce expenditure on contrast medium, scan time and radiation exposure. With the use of threshold techniques we believe that the pre-contrast hyperdensity may be detectable by a computer program that will facilitate diagnosis, and may also be modified to detect abnormal enhancement. Basal enhancement is a sensitive sign for the diagnosis of TBM and should be sought after contrast medium administration when no hyperdensity is seen in the basal cisterns or when this finding needs to be confirmed. The CT scan feature of hyperdense exudates on pre-contrast scans should be added to the inclusion criteria for the diagnosis of TBM in children.

Brain↗
PubMed2004

Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis.

Tuberculosis (TB) can affect any organ in the body. Children are a high-risk group for contracting the disease and pose a constant challenge to clinicians with regard to making a definitive diagnosis. Radiologists are playing a more active role in diagnosing TB, and armed with more accurate diagnostic investigations such as CT and MRI, they must face the cost implications as well as technical limitations. This review aims to guide the reader through the modern imaging techniques useful for diagnosing TB of the thorax, central nervous system and abdomen in children. The more specific features of each modality in the particular anatomical regions are highlighted.

Abdomen↗
PubMed2004

Idiopathic arterial calcification in childhood.

Idiopathic arterial calcification in infancy is usually fatal with death in early life and diagnosis at post mortem. This report describes a unique, late presentation with hypertension and cardiac failure in a child aged 33 months, found to have widespread arterial calcification at radiological imaging. The calcium-phosphate axis was normal and there was no other demonstrable cause for calcification. Additionally, the histological features of arterial calcification at renal biopsy paralleled the findings in infants with this disorder. The late presentation in this case is unusual and has not been previously reported. Ultrasound and CT are sensitive for calcification, and the disease should be suspected in children presenting with cardiac or respiratory manifestations and features of arterial calcification, where no metabolic cause is established.

Arterial Occlusive Diseases↗
PubMed2004

CT scanning for the detection of tuberculous mediastinal and hilar lymphadenopathy in children.

BACKGROUND: The diagnosis of primary pulmonary tuberculosis (PTB) in children relies heavily on the radiographic demonstration of mediastinal lymphadenopathy. Plain radiographs may be unreliable and CT is the current 'gold standard' for demonstrating this. Only two previous studies have described the CT findings of mediastinal adenopathy exclusively in children. OBJECTIVE: To determine the prevalence, distribution, characteristics and effect on the bronchial tree of mediastinal lymphadenopathy using modern CT techniques, in children suspected of PTB. MATERIALS AND METHODS: One hundred children (54 boys, 46 girls) with clinically suspected PTB were prospectively recruited from an overnight admission ward if they met the WHO criteria for suspected PTB. CT scans were evaluated by a panel of radiologists with regard to a predetermined set of criteria. RESULTS: Lymph nodes were present in 92 patients, and nodes greater than 1 cm were present in 46 patients. Enhancement of lymph nodes was present in 67 patients and was almost invariably 'ghost-like' ring enhancement. Calcification was present in only 9 patients. The most common location for lymphadenopathy was the subcarinal position ( n=90), followed by the hila ( n=85; left 74, right 72, bilateral 61), the anterior mediastinum ( n=79), the precarinal position ( n=64) and the right paratracheal position ( n=63). Multiple sites of involvement were present in 88 patients, and a single site for lymphadenopathy (subcarinal) was present in only 4 patients. Bronchial compression was identified in 29 patients. Most commonly, the left main bronchus was involved ( n=21), followed by the right main bronchus ( n=14) and the bronchus intermedius ( n=8), 16 right-sided compressions in total. CONCLUSIONS: Lymphadenopathy was common, but only 46 patients had lymph nodes greater than 1 cm. Enhancement characteristics of tuberculous adenopathy differ from that described previously. Typical enhancement was 'ghost-like' rather than discreet ring enhancing with a low-density centre. The site most frequently involved by nodes also differs from previous studies. The subcarinal region should be the site receiving most attention for the identification of lymphadenopathy, as this is most frequently involved and is also the site of the largest lymph-node masses. The presence of lymph-node groups at other recognised sites adds confidence when there is doubt, as multifocal involvement is common. Approximately one-quarter of patients with hilar adenopathy may have bronchial compression in childhood.

Child↗